Case Study: Nationalisation Versus Privatisation

Politics depresses me. For the most part I try and stay away. I blame TRIZ. Or possibly Edward de Bono. Or possibly Socrates. He was the one that forced politicians into thinking the world had to be either black or white, and that the way you decided the ‘right’ answer was through a combination of logic and who-shouts-loudest-wins. DeBono told us the better solution involved ‘designing’ a solution that achieved the best of both worlds. TRIZ tells us the job is to eliminate contradictions.

Both teach us that whenever we hear politicians arguing over A versus -A topics, they’re wasting their time. And ours. The only result, we now know, being that society as a whole is going to end up with the worst of both worlds. We’re told we need to privatise our national assets in order to make them more efficient. To achieve this, we introduce armies of ‘managers’ to seek out and deliver those efficiencies. The incumbent clinicians and medical staff think they’re idiots and so quickly realise their best strategy is to nod their heads, pretend to do what they’ve been told, and find secret work-arounds so they can keep on doing what they ‘know’ is the right thing to do. Do that for a couple of years and everyone begins to realise costs have gone up, patient mortality rates are worse and everyone is talking about leaving the profession. So then the nationalize-privatise pendulum starts swinging in the other direction. We tried one option and it didn’t work, so now we need to go back to the ‘good old days’ of the other option. It’s classic lose-lose behaviour. And it’s time we put a stop to it. Socrates, you’re fired.

Here’s a far better way of looking like any of these kinds of A/-A debate, whether it be nationalization-versus-privatisation, centralization-versus-de-centralisation, selective-education-versus-non-selective, or any other futile, wrong-question-dummy debate. They’re contradictions and need to be treated as such. It’s shouldn’t be a case of privatisation or nationalisation, but rather how we design situations in which society achieves the best of both worlds. Where everyone wins. The socialists and the capitalists. A ‘Third Way’. One that says, ‘let’s not meet halfway, but rather somewhere else.’

Map the problem as a contradiction and very quickly it ought to open up a host of win-win re-design opportunities. Here’s what that might look like for the nationalise-privatise story:

Figure 1: To Privatise Or Nationalise – Mapped As A Contradiction

Now, clearly, these kind of society-wise issue are massively complex and we shouldn’t expect that we can distil it down to a single contradiction. That said, we know that if we can get matters down to the ‘First Principles’ level (see the following article), we give ourselves the best opportunity to make progress.

First Principles, when we’re dealing with people, means recognizing that we do things for two reasons, the good one and the real one. This should tell us that, if we’re going to try and map the Figure 1 story onto the Contradiction Matrix, it will be helpful to map it as two contradictions: one examining the tangible (‘good reason’) situation, and the other mapping the intangible (‘real reason’). In this case, looking at the middle column of the Bubble Map, we get:

Tangible:
Market Demand versus Supply Cost – Principles 25, 13, 24, 4

Intangible:
Meaning versus Competence – Principles 13, 19, 2, 23

So far so good. We’re not the only people, the Matrix tells us, who’ve had to design a solution to these kinds of problem. The new challenge, now, is how we might meaningfully apply these abstract Principle solution suggestions to a problem as broad as nationalisation-versus-privatisation.

At the risk of offending every British reader (‘don’t touch our NHS’), I thought I’d try and describe an example system-level win-win solution that the Matrix might help us to design. Seeing Principle 13, The Other Way Around, appear in both the tangible and intangible problems, I thought I should start there. What to turn around the other way, though? That’s what TRIZ can’t tell us. Switch from top-down management to bottom-up? Switch from ‘clinical evidence’ to ‘no clinical evidence’? Slightly more controversial perhaps, but as far as I can see, not entirely without merit since, for the most part, the whole ‘clinical evidence’ schtick is made-up crap anyway.

Here’s another ‘controversial’ one: get people to get rid of the need for their role, rather than trying to preserve them. We know this works well in other industries, so why not the NHS? As a pre-requisite, people need to be given the clear assurance that getting rid of roles doesn’t mean they lose their job. Once that issue is out of the way, the eliminate-role first-principle turnaround transforms a vicious, lose-lose cycle into a win-win, virtuous one.

Here’s a specific example:

Radiology. Clinical evidence tells us very clearly that computer algorithms are already considerably better at interpreting x-ray images than even the best radiologist. That statement can sound very threatening if you’re a radiologist. You trained a long time to become a radiologist, so how can it possibly be that you’re not as good as an algorithm? And so, with this realization, the downward spiral begins – radiologists try and pretend the finding doesn’t exist (clinical evidence in real action!), they publish papers highlighting the dangers of computerised analysis to show the world how important radiologists are, and, in the background hidden from the public glare, they set up education programmes to ensure the next generation of radiologists compensate better for the failings of the current generation. The new generation of radiologists graduate, and the whole sorry tailspin starts another cycle. The moment you’re trained to be an expert in a subject, you’re inclined to protect those skills. Radiologists-create-more-radiologists. All the time this is happening, of course, patients continue to be unnecessarily harmed through mis-interpretation of their x-ray by the defensive radiologist. Everyone loses.

Contrast this with the following: the radiologists, instead of fighting the computer analysis algorithms, use their skills to make the algorithms better. They train the machines, instead of trying to dis-credit them. The patient immediately wins, because now they get a more accurate interpretation (the computer is already demonstrably better… clinical evidence), and know that the more time progresses, the better the algorithms will get. The radiologist’s primary purpose is now to help the algorithms get better, such that they can focus on the more difficult diagnoses. They write papers on their findings, which get shared across the whole radiology profession, such that every hospital needs fewer and fewer radiologists. The radiologists are expected to educate fewer and fewer new radiologists, but those they do teach get taught in such a way that means they graduate with higher and higher levels of skill because now they’re focusing on the stuff the computers can’t do yet. Their work becomes more meaningful, and moreover, the system then allows them to retire early if they want, or retrain to build other skills, or do something else that interests them. The point being that we turn-around the ‘preserve-radiologists-by-creating-more-radiologists’ ‘DNA’ into ‘create less radiologists’ in a way that allows everyone, especially the radiologists, to win. The downward spiral becomes a virtuous one.

It will take a generation or two, but if we translate the same Principle 13, turn-around from preserving-the-role to build-the-capability-to-eliminate-the-role to every other part of the system, we all start to reap massive rewards from the get-go. People are now incentivised to get rid of the in-efficiency-creating work-arounds instead of protecting them, all the meaningless work gets transferred to computers, and all the meaningful work gets preserved and expanded.

The same applies to politicians. My personal Rule #1: anyone that wants to become a politician should not be allowed to become one. Anyone that is a politician has an obligation to work towards eliminating the need for more politicians. Design-in meaningful endeavor; design-out meaningless either/or debate. Every complex problem can indeed have a simple, effective solution if we capture the right problems (root contradictions) and work to solve them at the First Principle level…